Family therapy: The basics and an intro to relational dynamics (with Marie Vakakis)

[00:00:00] Bronwyn: Hello, mental workers. You're listening to the Mental Work podcast, your companion to early career psychology, and I'm your host, Bronwyn Milkins.

[00:00:13] We know in psychology that we mostly deliver individual therapy, and that's what we're trained to do most of the time, like, if we go through uni the focus is very much on individual therapy and there might be a mention of couples therapy, if you're lucky, in a single lecture.

[00:00:30] Then when we go into our internships, again, it's usually very individual focused but what if something else is more appropriate for our clients? And what if that thing is family therapy? Here to help us unpack that is our guest, Marie Fakakas. Hi, Marie.

[00:00:48] Marie: Hello. Thanks for having me back.

[00:00:50] Bronwyn: My pleasure. So Marie on an earlier episode where they talked to us about family therapy and working with young people and their systems. And, Marie, could you just remind listeners who you are and what your nonpsychology passion is?

[00:01:04] Marie: I'm Marie Bakakis. I'm an accredited mental health social worker and couples and family therapist and I have a practice in Melbourne called the Therapy Hub, and then I have a training and consultancy business, marievakakis.com. I bring working together working with individuals and families all into the one place.

[00:01:23] Bronwyn: Wonderful. Thank you so much, Marie, for coming back on.

[00:01:27] And listeners, today, what we're going to do is we are going to present to you a hypothetical case study, and then we're gonna get Marie's help in unpacking how to conceptualize it, how to think about what's happening for the family, coming up with some potential strategies to help the family, talking about potential problems that might arise and how to overcome them. And by the end of it, hopefully, you should feel a bit more confident or just even knowledgeable.

[00:01:55] For me, I know very little about family therapy. It's something that I'm interested in, but just because I don't work with her, it's like, you know, I've got a million other things to learn so I'm really interested in this episode. Okay. And, Marie, does that sound good to you?

[00:02:09] Marie: Yep. That sounds like a supervision, but with a fake client.

[00:02:13] Bronwyn: Yeah. It does. Yeah.

[00:02:15] So for in preparation for this episode, what I did was I asked ChatGPT to write me out a case study. I think ChatGPT knows that I live in Australia, so it tried to make it local. But, anyway, let's get started.

[00:02:27] The Williams family resides in Melbourne, Australia. The family comprises Michael, forty eight years old, a dedicated high school teacher, Lisa, forty five years old, a part time graphic designer, and their two children, Olivia, seventeen, and Ethan, fourteen. On the surface, the Williams family appears to be leading a content life, but beneath the facade lies a complex web of issues that has prompted them to seek family therapy.

[00:02:52] Chat GPT got a bit ominous. Okay. Let's see what's happening.

[00:02:56] Michael, passionate about his teaching career, has been grappling with work related stress leading to fatigue and emotional exhaustion. Lisa, while managing her graphic design work and household responsibilities, feels a growing sense of disconnect from Michael. The couple's communication has dwindled, and they find themselves caught in repetitive arguments that go unresolved.

[00:03:15] Olivia, a senior in high school, is preparing for uni and feels overwhelmed by academic pressure. The stress has strained her relationship with her parents, and she often feels unheard and misunderstood. Ethan, In the midst of adolescence is struggling with its own set of challenges, including issues with self esteem and difficulty expressing his emotions.

[00:03:34] The household atmosphere has become tense, and the family unit, once tightly knit, is now strained. Most of the time, no family member can speak to to each other without an argument breaking out. Recognizing the need for intervention, the Williams family decided to seek the help of a family therapist. They hope to rebuild communication, address the individual challenges each family member is facing, and ultimately restore a sense of unity and support within the family.

[00:04:01] The issues they bring to therapy include strained spousal communication, parental stress impacting the children, and the need for a more connected and understanding family environment.

[00:04:12] I can read out parts of that again if you need it, obviously, that was a big info dump.

[00:04:17] Marie: No. I think that's good. I think we're I mean, do you have any initial questions for me? Like, how would we kinda get this started?

[00:04:24] Bronwyn: The First thing that runs through my mind having been trained in this very individual lens of seeing therapy and interventions is, well, why not just grab Michael and his wife, Lisa, why not just put them in couples counseling, put the kids in individual therapy, and bam, and there there we go. Like, why why would we consider family therapy as an intervention?

[00:04:46] Marie: Well, it's it's interesting because you could do a combination of that when you're working with the family. But I think, and I guess following on from our original conversation, we looked at this is it doesn't always have to be perfect pure family therapy to be thinking about the impact a family. So if you've got Olivia as a client, and I'll go with her because that's the age group that I would mostly see, it would be very helpful or to be teaching her breathing techniques and basic CBT and diffusing from negative thoughts if you're using ACT.

[00:05:20] If she's going home and her parents are in distress, they can't communicate properly, they're feeling anxious, they're overwhelmed, maybe the comments that they and make further exacerbate her distress. We're focusing on one piece of the of the puzzle and it's the person who's probably got the least amount of power or one of the least amount. So she's self harming, for example, just trying to teach her coping strategies without looking at how do mum and dad respond. Are they approachable when she's feeling overwhelmed? Do they get so anxious and overwhelmed that it exacerbates her distress. So we're looking at these patterns. So when we're looking at the family system, we have to look at that that relational component.

[00:06:01] Bronwyn: That That makes sense to me because in the case study, it says that Olivia is preparing for uni, feels overwhelmed by academic pressure, and then it also says that the family can't talk to each other without an argument breaking out. So let's say we did teach Olivia, like, okay, let's make space for that discomfort, that overwhelm that you feel about uni and you can let it be there, and you don't have to respond to it straight away.

[00:06:25] Whereas if she goes home, if the parents are like, have Have you thought about what you're doing for uni? Like, we need to sit down and talk about your uni choices here and what you're prioritizing, that strategy would come into conflict with that.

[00:06:36] Marie: Potentially, and also each person will be focusing on what they want the other person to do instead the role that they play within that system.

[00:06:44] So you might have mum or dad just say, "if only you could just do this, then we would be fine". And then you might have Olivia saying, "If they would just get off my back, then I would be okay". So we're also looking at this level of emotional maturity that each person can start to take some responsibility for how they respond or how they react or how they show up in that dynamic.

[00:07:08] It's like a dance move. Right? Like, you can't choreograph a two person dance on your own. You need that other person there.

[00:07:15] Bronwyn: That makes sense. So with with this, like, are we getting all four of them in the room at the same time, or is it Olivia with the parents or the parents themselves? Like, how do you decide who to have in a room with family therapy?

[00:07:30] Marie: It depends on how the referral comes and whether people are asking straight for straight family therapy. So if this family contacted us and saying we wanna come as a family, we might do a bit of an brief session. It might even just be on the phone to sort of say, what are you what are you needing? What's kind of happening? And then sort of maybe figure it out. Because if they're like, oh, we're all coming because we wanna fix Ethan, I'm like, well, maybe that's still valuable. I feel like I would be equipped enough to hold space for that. And I said, look, let's all come in, and then, you know, if Ethan's coming and being like, "I don't know why everybody's here". This is, you know we we'd work with that in the room.

[00:08:06] And I would have in that first session, " Why now? What's happened? What's triggered this most recent help seeking session or time?". Like, "what what's what's happened? Did Someone have a fight? Did someone storm it?" Like, actually understanding " why now" is really helpful because the families have their own resources, and something throws the equilibrium out sometimes. And we wanna see how we bring that back together.

[00:08:34] So we see patterns across transitions like developmental milestones, a death in the family, going from primary school to high school, from high school to uni, like, these kind of big transitions can sometimes take families a bit of time to find their balance again. So it would be really understanding, " Why now, what are they hoping to get out of it and understanding like you would for individual therapy. You might phrase it differently, but what are their goals for treatment? What would it look like if a after a few sessions, this was helpful.

[00:09:08] Bronwyn: That's that's a really good point. Yeah.

[00:09:11] Because in the case study, we don't actually have a "why now". So you're saying that some of the "why nows" you might see is that there's an external events. So say there's a death in the family or people are going through life transitions, and then it places strain on the family?

[00:09:27] Marie: It it could. Yeah. Absolutely. And that'd be part of the case conceptualization. So you would be Formulating a bit of a plan, and you would be reworking it in your mind to think about, you know, what's the background? What's happened recently? What are some key milestones that have happened over time that might relate to that particular distress or particular um, concern that the family has, you'd be looking at the family structure. Are they separated, divorced, blended family? Like, what's happening? And then the way everybody interacts gives you information. It's already showing you, are they enmeshed? Did someone talk over somebody else? Can you see how their attachment styles play out in the room. Like, all of this is really rich information. Does someone take up a lot of space? Does someone not have a voice at all.

[00:10:16] All of that is information that you won't be able to get if you've just got one person there.

[00:10:24] Bronwyn: That sounds like a lot. You know, when I'm working with an individual client, I am thinking how they interact with me. So sometimes I'm like, are they not saying much? Are they being agreeable with me? Or Are they talking over me? And I look at that relationship dynamics, but I've only got, I guess, three relationships to keep track of, the relationship they have with themselves, our relationship, and then my relationship with myself. In a family situation, that's, like, at least four different relationships.

[00:10:59] I'm wondering, could you take us through, like, a basic way, if possible, of conceptualizing a family?

[00:11:07] Marie: It it's hard because there's no one basic way, but there are some patterns that we'd look out for. So it might Be something like a distancer or pursuer. It could be that every time one person says something, the other retreats. So we might be looking at themes. And coming at it with curiosity, it might even be saying, can I just pause you there, Michael? When I see Lisa try to express what she's feeling, I get the sense that you're really frustrated. What's happening for you right now?

[00:11:37] So you you get to interrupt that and bring new information into the system. So it could just be Olivia every time mum tries to show she's understanding, I see you get really angry that she, it sounds like you feel like she's maybe belittling you. Like, what's happening there for you?

[00:11:56] And you get to translate some of those moments live in the session. So even just looking at how each person responds and being able to say, "is that what you meant by that, Lisa? When you asked Olivia, how did school go? Were you meaning to be interrogative?". She's like, "no, no, I didn't", you know? So you get to really notice those patterns.

[00:12:20] Bronwyn: And is this something that you write down, I guess? Like, for yourself, you're quite an experienced family therapist. So you've done a lot of training and you supervise family therapists. Maybe when you started out, is this something you would write down, or is it now more something you keep track in your head.

[00:12:38] Marie: I still do a combination of both. I have a number of, like case note templates that I'll use depending on who's presenting to me. So if it's a couple or individual or a family. And I'll still kind of jot down notes in particular categories. So if you're, you know, if you're very attachment based, might have some of those fields already kind of pre-made and you just you get to tick which box it is. Like, you get to have some of those tools depending on your particular background. When I was studying family therapy, we had the benefit of a lot of the sessions were recorded so you could go back and rewatch them and sort of notice some of those things and you have people watching you live, so you get that constant live feedback as it's happening, which is very overwhelming at times, but really helpful.

[00:13:25] Bronwyn: Yeah. So I guess what we're up to is really the assessment. It's like If we brought the Williams family in for a session, we'd wanna be looking at these dynamics between them, picking up on patterns and themes, really getting a sense of the why now and their goals. Is that right?

[00:13:45] Marie: Yeah and then I would be looking at like you do with some individuals, you'd have some miracle question like, "If the problem was was resolved overnight, what would be different?" You can ask questions around, "what have you already tried? What are you hoping would be different this time?". So sometimes that can be really helpful. And having young people sort of say, like, "when I hear mom and dad fight, this is the impact it has on me" or you know, you get to hold space for that. It's not that you're being an umpire or referee, but you really set up that system to sort of trust you and not as coming, like, that power over as an expert, but actually saying "there'll be times where I will interject. Is that okay?". "Can I have permission to interrupt you if I feel like we're getting off track?". "When someone says something, I might pause things there. I might make note of something to come back to. Is it okay if I interrupt?" So you're seeking permission to to interject or to pause or to paraphrase so you can capture some of those things live.

[00:14:51] So I'll give you an example. I mean, this is a very common sort of presentation um, you know, the two parents, two children kind of scenario where I had a family where every time the young person would speak, I would see the parents get quite activated and it kind of was a light bulb moment where I was like, oh, you perceive their tone as rude. And the parent was like, yeah. I'm like, that's interesting because they use that same tone with me. They're not being rude, I think that's just their tone. And that you could see the whole family, like, they'd never thought of that before. You know, I see it a lot with maybe some of my autistic clients where they might be quite maybe frank in their communication style or quite direct, and the parents are getting very activated by that. They're thinking they're being combative or they're being sassy or being rude or argumentative, and the young person is completely confused and then I have them in the session, and I see them talking, and then I can comment on the parent's response like, oh, when let's just say it was Ethan who was presenting that.

[00:16:03] Like, when Ethan says this, I sense something's happening for you? What's going on? And they can say it as being really rude or as being aggressive. And I might be able to offer more information by saying, actually he speaks like that when it's just the two of us, or I don't think that's where it's coming from. Can I check-in with you, Ethan? So we get to bring in more information really, like, live into the system.

[00:16:30] Bronwyn: Maybe something that's a theme or a pattern that you would conceptualize in families, like a series of misunderstandings or expectations that aren't, I guess, fair or unkind from parents to kids of young people and then maybe the goal of family therapy is helping them understand each other from a different perspective.

[00:16:58] Marie: I think that's definitely one of the goals. There's so many different modalities of family therapy and it would be like if we were talking about individual therapy. Like, you would have, you know, EMDR therapy, schema therapy, CBT. We have all these modalities. Family therapy has all these different modalities as well.

[00:17:17] Bronwyn: Could you tell us what a few of those are, because I literally know I've heard of Bowen, and then I and then my mind is, like, blank and there's a tumbleweed.

[00:17:26] Marie: Well, there's systemic therapies. There are strategic therapies. We have sort of this narrative therapy that comes in, like family therapies, but if we're looking at couples, then that's a whole different ballgame where we have EFT and Amargo and Gottman, there's experiential. So there's structural, there's solution focused.

[00:17:44] There's different things and each one has slightly different ways of conceptualizing what's happening in the system.

[00:17:51] Bronwyn: What's your favorite one?

[00:17:53] Marie: I quite like Bowen.

[00:17:55] I work from that probably more. That felt the most natural for me. And then, like, with individuals, maybe I might borrow tools from other practices where it's like, well, like, you know, I might pinch that kind of that question from this, I like that assessment tool and bring sort of things in, but my overarching model is looking at Bowen with an attachment sort of lens because that also fits in nicely with my couple's therapy.

[00:18:19] Bronwyn: Yep. And I Don't mean to make the podcast an exam, like, with putting you on the spot, but but could you just tell us, like, what Bowen Therapy is. Like yeah.

[00:18:32] Marie: Oh, now you are putting me on the spot. No. That's okay.

[00:18:36] Doctor Murray Bowen was a psychiatrist, and he was looking at how people respond in particular, I think it was around psychosis. Trying to think. It might have been. And he sort of looked at the patterns of maturity and how it's that real focus of the relational component and what we bring to something rather than the blame on someone else.

[00:18:59] So it's really around focusing on the bit that we can control in different relationships and then there's different sort of tools and techniques around that. There's that sort of this trying to find this balance of togetherness and a need for autonomy. So differentiation in a healthy way. So it's not being like, if you're fighting against something or you're completely pulling away, neither of those is that sort of healthy, mature, differentiated adult.

[00:19:30] Bronwyn: That sounds like I would I was wondering whether it's a common thing in family therapy for families to come in and be like, "They are the problem. Like, the young person is the problem or x is the problem, if only x did things differently, then things would be better".

[00:19:47] Marie: Yeah and there's a really great article. People can look it up. It's by Doctor Jenny Brown, and she it's called, "We don't need your help, but can you please fix our children?" and we've spoken about it on my podcast, a very similar topic, but for parents and I've spoken on her podcast, The Parent Hope Project, about a similar thing, but it can be very much that everything would be fixed if this person just got fixed. And that again, it's that that's not really differentiated. It's not that togetherness and separateness. It's not allowing space to grow, but also maintaining connection.

[00:20:21] So those are the ones that if we just kept focusing on individual work, we're feeding into that belief that that person's the problem, that they're the identified patient.

[00:20:33] Bronwyn: Yeah, because I'm imagining a situation, like, let's say that, the "why now" for the Williams family. Let's say it's like Olivia stayed out past her curfew, and then she got grounded. She thought that was unfair, so she ran away and stayed at a friend's house for a week. And then Ethan didn't talk to his parents for a week, and then they all didn't talk to each other, and that was they're like, 'why now'? It's like, okay, we are not functioning as a family.

[00:21:04] Maybe the parents would come in and be like well, if Olivia just stuck to the rules that have always worked then this would never have happened.

[00:21:14] Marie: If you were working with Olivia and that was... she was dropped off to you, and mom's like, "I'm just gonna come in quickly and just let you know what's happening. Can you get her to be more I don't know, Obedient". How would you start that as an individual session? And then maybe I can share what I might do.

[00:21:30] Bronwyn: I think I would try and get a sense of Olivia's perspective. And I guess, like, as an individual practicing from a humanistic standpoint, I would have... I I mean, I always say this to my client that I'm on their team. It doesn't mean that we won't have difficult conversations, but In that original initial session, I would be really trying hard to understand Olivia and her sense that she is un unheard, misunderstood, that this was unfair, and then maybe for interventions going forward, I might try and recommend how she can assert her autonomy and communicate as best she can with parents who maybe or maybe not will change or be receptive to her, asserting her autonomy, and then acceptance around that maybe her parents won't change or maybe they will and how she can cope with that?

[00:22:27] Marie: That sounds really good.

[00:22:29] Bronwyn: That'd be my best guess.

[00:22:31] Marie: Yeah, and then and then if in between mum keeps emailing you saying, why isn't she listening? Why isn't she responding to curfew?

[00:22:40] Bronwyn: Oh my god. I'd probably set some boundaries with the parent and I tell them that that like, I might tell Olivia that mom's really concerned about this feels like I don't keep secrets. So mom has shared her concerns in this email to me.

[00:22:55] Might tell mom that things could be... if I'm persisting with individual, I would say maybe, mom, we can talk at the end of the session individually about your concerns. I don't know what I do actually because I don't I don't work in that way but I wonder if, like, I would be like, I wonder if I would talk with mom about how seeing Olivia as the problem is furthering her her alienation from the family or something.

[00:23:20] Marie: Yeah. So you're already... some of it's already sort of it overlaps because that might be a common presentation. It's very it's not as common for people to present with family as family therapy because I know in the states it it does come under a lot of the insurance companies. Here, it's not Medicare care rebated and a lot of people... it's just not a popular or well known sort of modality. So I would be looking at that let's say it's that dynamic, making sure you don't get triangulated in so that you're then the the good guy or the bad a guy in this.

[00:23:52] Right? Because then it's Oh my therapist said, but you're not doing this. So we really want to make sure that we don't get stuck in that system and then also looking at what role does maybe dad play in this. Because if mom's then fighting with Olivia, and then what does dad do?

[00:24:07] So sometimes it's actually, those first few sessions might be in saying, I'm still doing my assessment. I'm trying to understand where you get stuck in your communication and I know you have different priorities or different things you'd like to get out of the session. It'd be great if you could bear with me. I will come back to all of your concerns at some point. It will take some time. You know, sort of use an analogy or metaphor or something mean, it talks around how you do your assessment, if that is what's needed to keep their expectations at bay of what you can and can't achieve. And then it might be okay, so what happens then? Okay.

[00:24:43] And then when Olivia does slam her door, what does mom do? And then where's dad when this happens? Okay. And then what happens to Ethan? So it might be that sometimes you map it out on a whiteboard in front of people, sometimes you're just writing notes, but it's really starting to trace the process and trying to see what happens at each stage and you might have to avert something like, look, I can't get anybody to follow any rules or anything like that. What I'm hoping to do is to get you all feeling more connected, or that, even if Olivia makes some mistakes, that she still feels like you love her. So you you you're trying to kinda see what's what's conditional on her behavior. Is love being withdrawn? Is she feeling criticized. Can the parents hold this ability to be like, I'm unhappy with your behavior and I also love you? There's so many different things that could be happening that you're trying to unpack and understand.

[00:25:40] Bronwyn: I guess one thing that comes up for me is I'm like, given that there's so much to unpack and maybe so many concepts to go through with families, how long does family therapy typically last, and how long do people come to sessions for? Like, do they expect a one session fix, and they're like, I can't believe that we're still here five sessions later.

[00:26:02] Marie: Some... some do. And there is some research that La Trobe Uni, the Bouverie Center has done around single session family therapy that has shown some promising results. It really depends on knowing their expectations and what they're hoping to get out of it. So I've worked with families who an episode of care might be until one particular symptom is reduced, and then things go back to this is good enough.

[00:26:29] Bronwyn: So, like, let's say with the Williams family, if they could just have a conversation, and it doesn't lead to an argument... Would that be an okay goal for family therapy? Like, is that good enough?

[00:26:43] Marie: If that's if that's their goal, that it's really for them. Even in the goal setting, that might be information. Right? If mom's like, I just want everybody to want to spend time together. And it might be sort of, well, you've got two teenagers who are differentiating, seeking their autonomy, they might not want to spend as much time with you. That might be mom's needs. So then you might be looking at her maturity. What's that... what's that serving? What's her need there that's being met or not being met? Is she focusing too much on the children instead of in the marriage? Are there stories or experiences in her past that's maybe leaving her to overcompensate in an area that she wished she had.

[00:27:26] So there's room to to examine or or kind of shine a spotlight on some of those different areas and be curious. Like, where does that come from? Tell me more about that. Does that remind you of something that happened to you as a child or, you know, going in with this idea that families are doing the best they can with what they've got, and I've yet to have a parent come in who really wants to get it wrong. So even going, I can see that you've done everything you know how to do and I wonder if when you get overwhelmed and you get scared, you come across as a bit more assertive. Would that be fair to say? Okay. So then when you're assertive, Olivia interprets It's that as critical. Is that right, Olivia? Okay. So when you feel criticized, what happens for you? Okay. And then when you do that, then what does mom do?

[00:28:19] So sometimes you get to put words to that and create some of that empathy because sometimes scared people act really cold or they overcompensate. So sometimes you can bring attention to those different components of the conflict or that pattern. And that sometimes sometimes that can be enough to settle the system where they're like, oh, so when mom does this, it's not because she thinks I'm crap or irresponsible. It's because she's scared. Then they might be able to compromise or negotiate from a different position.

[00:28:56] Bronwyn: Developing that empathy, which can be a sign of emotional maturity, seems to be important.

[00:29:01] Marie: Yeah.

[00:29:02] Bronwyn: So with the Williams family, let's say their goal is that they just wanna all get along. Like, they just wanna be able to be in each other's presence. They just wanna be in the kitchen and if someone says pass me the milk, it's not gonna be an argument that breaks out. So they wanna have better communication. The parents, they wanna feel respected. Let's say that that's their two main goals... these are probably fairly common goals that you might see in family therapy.

[00:29:34] Marie: Yeah.

[00:29:35] Bronwyn: Yeah. How would we approach that in general? Is it building the empathy? Like, do we have any I guess, interventions or techniques at our disposal?

[00:29:47] Marie: Yeah. Again, it's you can observe it happening so then you know which sort of pattern or trait is regular for that family. But for example, when it comes to spending time together, one of the things that I hear quite often, and I've observed probably personally, professionally, I hear it in, like, out and about when I'm having dinner. Like, people will won't say... they won't say something like, I really wanna spend time together. Is there something we can do that's just us? They'll will say something like, it's so nice of you to finally join us. And they use that at that tone or out of guilt. It's like, oh, so your friends are more important than us, aren't they? And that doesn't make people wanna spend time with you.

[00:30:33] Bronwyn: Yeah.

[00:30:34] Marie: And so sometimes I might even comment on that process of like, well, how are you actually asking? Because I know if someone said that to me, I'd be like, well, well, I don't want to now.

[00:30:46] Bronwyn: Yeah.

[00:30:47] Marie: Or it it gets your... gets you activated in more, maybe, combative argumentative. You'd be like, well, I spent time with you last week... and then it's like it starts to feel like a chore. So I think it's very different to come at it from a point of vulnerability of I really wanna spend time together. I appreciate you've... you know, you're growing up. You've got your friends. Is there something we can do once a fortnight or once a month? Or can we have uh, can Thursday nights be family night? Then you can come up with some practical solutions. But if you're coming at it straight away from that, you never spend time with us anymore or oh, look how good your sister is. She hangs out with us. Like, if you're doing comparisons, passive aggressive, you're criticizing, you're using maybe threats or guilt, that's not a helpful strategy.

[00:31:36] Bronwyn: What if in the family, there is a culture where we don't share feelings of vulnerability, and that's a passed down message from their parents. Is that something that you might have a look at in family therapy? It's like, what are the rules of our family, and what are the allowable things and not allowable things?

[00:32:00] Marie: It depends how much time I had. Like, that would be a really great piece to actually do some psycho ed around. Some families don't absorb it that way. So it might be very experiential where if that's your hypothesis, then you might say, okay, so Olivia, when mom said it's because she misses you, I wanna spend time with you, How did that sound? What's it like hearing mom share some more feelings with you? So you might get Lisa to realize the benefit of sharing feelings by focusing on the impact it's had on Olivia. So you could be teaching them through the process as you... instead of just saying, like, we all have metro emotions, so we have beliefs about feelings. And so that that might be, you know and I do that in parenting courses, like in tuning into teens or when we're we're looking at understanding those concepts.

[00:32:51] But in the room, it could just be... if it's between Michael and Lisa, like, Lisa, when Michael says, I'm actually feeling like I don't know where to start and I'm overwhelmed, what's it like for you to hear that? So you can teach them the value of it by showing them the impact it has live.

[00:33:10] And if they really struggle to articulate it, then you might offer that, okay, so what I'm actually hearing and and feel free to correct me if I'm wrong is you're really scared, and when I heard make those comments to Olivia they were coming from a place of fear and worry. And you, you know, you can bring that down.

[00:33:32] And then if mom's nodding or, you know, says no, it's actually something else. But let's say she says, yeah. That's right. It's like, Olivia, what's it like to know that mom's actually really scared. And you can bring it down. And so you can teach it live.

[00:33:48] Bronwyn: That sounds like really powerful teacher to teach at life. And it it just struck me, actually, that how I would think about that it's a lot of process comments. So I guess here and now comments. And I remember when I was starting out as a psychologist, that was really hard for me to to do that. I either thought that... well, I either missed the moment. So it's like something could happen, and then I'd say something, and I'd be like, crap. I missed that. And then I wouldn't know how to come back to it. Or I'd say something and then get it wrong and be like, I'm never doing that again. Um, But I guess, like, is is that right? Like, a lot of what you do in family therapy can be, like, here it's, like, about the here and now and the process that's happening in the room.

[00:34:35] Marie: Yeah. Absolutely and I think even if you go in just with that, that's a really powerful intervention in itself.

[00:34:42] Bronwyn: Because, yeah, it really... rather than doing the psycho ed, like you say, it really demonstrates to them in real time the interaction between each other.

[00:34:52] Marie: Yeah.

[00:34:52] Bronwyn: Yep. Is there anything else that you might consider for this family?

[00:34:59] Marie: If it was a family that presented like this, I would have them all in at the start and then it sounds like if the parents aren't really on the same page, then I might recommend further sessions be just a couple.

[00:35:13] Bronwyn: Oh, okay.

[00:35:14] Marie: And so then I would be looking at either exclusively couples therapy or couples therapy with the family still being the client. So it really kind of depends on whether I'd be doing a full sort of couples therapy assessment and looking at all the areas of their relationship and their trust and commitment and I use the Gottman method quite a lot in my assessment. So, you know, whether I look at all of that or whether I have several sessions and sort of still bringing it back to their parenting distress. So it it can really depend on what's the bit that they want to focus on and improve.

[00:35:51] Bronwyn: And just a practical question with that... if the family is the client and then you're having sessions with just the couple, do you, as the therapist, see them as the family and the couple, or is there some reason why you would need to seek a separate therapist for the couple versus the family sessions?

[00:36:11] Marie: I think it depends on your modality and and how you practice. I would take it case by case.

[00:36:17] For some, I might sort of... if it's very clear, and we've had this, you know, a number of times at the where parents brought in a child and I'm like, their child is reactive to the couple's anxiety, so I actually don't need to see them ever again. The work between the two of you is the most beneficial here.

[00:36:34] And so it would be around how you set up the consent process, how you talk about who's the client, how you sort of... you know, if it's full family work, you might be saying, I'm not keeping secrets. Not being pulled into these things. But then if you know, in the parent session, they're talking about I don't know, a recent miscarriage or a health scare. It might be that you're saying, look, I'm not going to hide that from your children. I'm not gonna blurt it out, but we can't keep those secrets.

[00:37:01] So you're you're really using your judgment on how to bring that up. And if you're doing that kind of in-depth family therapy, you'd hopefully have more extensive family therapy training, a family therapy supervision, more sort of guidelines around sort of the ethical considerations of that. So if we bring it back to the, you know, psychologists or therapists who work individually trying to conceptualize a bit more systemically, you might might not need to be thinking about it in that sort of detail just yet.

[00:37:31] Bronwyn: That makes sense. And I guess if people are unsure about what to do in that situation. It's a good idea to seek supervision?

[00:37:38] Marie: Oh, absolutely. I mean, I would be seeking supervision consistently as part of your reflective practice, whether that'd be weekly, fortnightly, monthly. Like, whatever it is that you feel you need , to improve your... your skills, to case conceptualize, to have your diagnosis or differential diagnosis, like, you would be wanting that as part of your practice anyway.

[00:37:59] Bronwyn: Totally. Yeah. I'm just wondering... This is a a a different question, but let's say, like, with this family, with the Williams family, like, they have come in and they're like, every time we talk to each other, we get into an argument. So unless they're all being very performative, it might be reasonable to expect that they're gonna have an argument in the therapy room. Someone says something and then it sets off. It triggers somebody else, and then they're in an argument. Do you, A, sit back, watch the argument, B, stop it before it gets out of hand, C, something else?

[00:38:35] Marie: I would do a mixture of all of them at different stages. So maybe the first few sessions, I would let it kind of play out as long as it's still safe and just observe what happens and then actually share later on, like, thank you for letting me see how tricky things get. This gives me an idea of where you get stuck.

[00:38:56] Bronwyn: Okay. Cool.

[00:38:57] Marie: So I would say that being able to to witness this and, you know, you wanna ask someone, like, if it's, you know, between Michael, Lisa, and Olivia, and Ethan, they're going like, oh, fuck. You know, it's like, Ethan, does this is this what happens at home? Yeah. And does Lisa normally... does mom normally yell at Olivia? Yeah. And does Olivia storm out? Yeah. So this pretty much happens. You're not kind of filtering it for me. It's like, no. Okay.

[00:39:20] And then you might turn to the family like, thank you. I can see this gives me so much information of where you're getting stuck. I can see some of the things that you're really trying to do that I'm landing the way you hope. This has given me something to think about and bring to our next session. So you can sort of use that as part of your assessment, and in couples... there in Gottman couples there being particular, that's actually forms part of the assessment is to get them to reenact or bring in an argument and not and not intervene. Just let it... And you would ideally videotape that as well so you can rewatch it later or watch it with the couple and use that as part of the formulation.

[00:40:01] Bronwyn: Wow. Oh, I didn't know that. That's really interesting. Would you say as a family therapist, like, I know some people, they... inside themselves, they feel very activated when they hear people raise their voices because of their family history. They might not like hearing raised voices or arguments. How would you recommend someone who is a therapist who has that, like, help themselves, I guess?

[00:40:26] Marie: It's really important because the family in front of you can only differentiate as much as the therapist is. And so you need to have a stance of non reactivity. So if there are particular areas that evoke a response in you, you have to get supervision for that, and you might even need therapy.

[00:40:47] Bronwyn: Yep. Yeah. Totally.

[00:40:48] Marie: And little bits of that could provide information that is relevant to the system around, Ooh, I find that I have that response. Is that because I felt like Olivia? My mom always was hypocritical? Or is it, okay. So I can sense this thing in mum... I wanna explore that a bit more. So you can you have to keep a practice of knowing yourself and I don't know about you or your listeners, but I wouldn't ever go and see a therapist who wasn't in their own therapy or hadn't had their own therapy before.

[00:41:20] Bronwyn: No. We love therapy on this podcast, and we've talked about it in episodes, therapists in therapy.

[00:41:25] Marie: I think it's really... You don't want someone who hasn't experienced the discomfort of of being there. You want I want I'd want to know that someone is willing to do the tough stuff that they're telling me to do...

[00:41:36] Bronwyn: one hundred percent.

[00:41:37] ... and they're able to, you know? Get their shit under control.

[00:41:41] Bronwyn: Yep. No. And, yeah, we've talked about it in the therapists in therapy episode, but, you know, it's so valuable to be the person in the hot seat who has to be vulnerable, go through difficult emotions, and face the discomfort of perhaps, like, changing approaches and behaviors and knowing how difficult it is. It gives you a whole different perspective as well as helps yourself.

[00:42:03] Marie: Yeah. And you can then bring that information back into another session. Like, if you really did feel like you got something wrong, then you can say, last session, I was really taken aback by what Lisa said to Olivia, I wanna revisit that for a moment. And so you might wanna revisit that or you might need to find some support to figure out what is it about that interaction that evoked a response in you, and are you siding too much with one or the other? Are you are you holding this , this, you know, multidirectional like, this impartial stance, or are you aligning with each one? Because that'll change what you ask. It'll change how you say things. If you're a parent who's struggling with a teenager who's trying to individuate, this might be a invoking feeling like, oh, how dare they? Oh, what a little, you know, so and so. Or vice versa, if you were the teenager who felt micromanaged, then you might be taking that sense. So you want to have this this neutral position in a way.

[00:43:02] Bronwyn: Yeah. Totally. And one last question I have about that is, I I bet this happens because I don't see couples either. But, like, I'm just wondering if this happens in family therapy where somebody's like... let's say there's, like a a remark under someone's breath, and they're like, yeah. She never has a go at Olivia. Like, Olivia is the perfect one. She loves Olivia. Olivia is the favorite. And then the family perceives that you have a favorite. What would you do there?

[00:43:31] Marie: So if someone like Ethan was sort of like, oh, here we go again.

[00:43:34] Bronwyn: Yeah. Like, Olivia's getting all the attention or, like, you know, Olivia's getting the compliments.

[00:43:39] Marie: Then then that might be an indication of one of the things that the family really struggles with. So you might be like, yeah. I can see how because Olivia's got a lot going on right now, she seems to take a lot more of mom and dad's attention. And, yeah most of the session has been about what she's struggling with, so can I can I come back to you? Like, what's that like for you?

[00:44:02] And and you can make some guesses. Like, sometimes I kind of guess, you know, it's like, oh, it sounds like you're working really hard and no one's noticing that you're trying your best to be a good student or, you know, you you can find that that nugget of something hopeful or optimistic and sort of bring that to the attention like or sometimes it's, you know, one kid doesn't get the attention because parents are like, oh, thank god. You're the easy one. And so then they squish down their feelings.

[00:44:30] So you might if you notice that in the session, you might be documenting that in your case notes as part of your conceptualization. So it could be, you know, let's say we we found that Olivia had a early childhood acute illness, and so the parents have become really fixated on her because she was very unwell.

[00:44:49] You can see that there might be some hypervigilance there and they might be like, oh, cool. Ethan was born with no defects, no congenital heart thing, whatever the illness was. So he's all good.

[00:45:00] And then he might learn, oh, when I have the need, it doesn't get noticed. When I need something, it's overlooked. No matter how hard I try, it's not enough. So that might have shaped how he adjusts and adapt. So then you might have some sessions where it's like, Olivia just sits there silently, and you're like, what's going on for you? This is what I'm noticing. And and you can kind of draw the attention to that person. So it really sort of depends on your case conceptualization and I would be drawing a sort of genogram, looking at the relationships, noting down some of those interactions, jotting down some of those things as key quotes, and then thinking about how do you bring into the system, what's most useful or what's going to kinda loosen up something that might improve something somewhere else. It might be what's a low hanging fruit. Like, you've gotta make your assessment there.

[00:45:53] Bronwyn: That makes a lot of sense. Sounds good. With family therapy, do you see that, in general, it's quite helpful for your clients. I guess I'm just thinking, like, it sounds so hard, and, obviously, it does require some unique training to be able to do it. I'm wondering yeah. Like, does it work?

[00:46:17] Marie: It does and I think I can't remember who's who said this quote... it's something in the lines of what's... what's hurt or broken in a relationship can only be healed in a relationship.

[00:46:29] So you could do all the individual sessions you want with one person, and it might not actually have any impact if the... if what's hurt them or what the damage was done was in relationship. So it might not be in that relationship, but you see that parents will be bringing into sessions issues that are triggered or activated by their partner from their childhood. So that can be healed in relationship. There's so much power in that happening live there with you.

[00:47:04] Bronwyn: Absolutely. Yeah. And I often... that's the perspective I take for gaining a secure attachment earning a secure attachment. And I'm like, this needs to happen either in the therapeutic relationship or in your relationship that you have that's important to you outside of therapy. Either way, like, this healing takes place through a relationship.

[00:47:20] Marie: Yeah. Exactly. But also you give them a chance to share things that they might think are implied. When I first started, I was at your most basic. It might be I had a deck of Strength cards. And it might be something as much as at the end of the session, I would bring a parent in and say, alright so we've been working on self esteem and of confidence, and one of the things that I'd like to do is get you to pick out five strengths for your child and an example of how they've used each one.

[00:47:51] And so it might be something as small as that, and maybe that young person has never heard that their parents say, I think think you're brave, you're really funny with examples. If it was with a couple, I might do something like, Can you each share with me something you really admire about the other person and an example that comes to mind?

[00:48:12] Or I'd like you to share three things that you really appreciate about your partner. So sometimes I get to scaffold and bring in some of those good things that some families maybe don't say or they think they're implied or life gets so busy, it's just not part of their daily vernacular. And that in itself can be really helpful because you could spend all your time with Olivia doing all the strength based stuff that you want, but someone else saying those things about her, someone that's as, you know, a primary attachment figure can be really helpful.

[00:48:48] Bronwyn: Some of the best... oh, some of the nicest moments I've shared with clients has been when they've done, like, a strengths based activity, and they've taken it home and the homework has been to get their partner to really say that their strengths are and the examples, and then they're like, I framed it. It was really awesome. Like, I loved hearing you know, it's it's something I look at when I go out the front door now. Yeah. It's really powerful hearing it from a from an attachment figure.

[00:49:16] Marie: Yeah. So you can you can start off in a very gentle way introducing family or the system into the individual therapy. It doesn't have to be a full go do a family therapy masters. And I'm talking to you Specifically?

[00:49:32] Bronwyn: Yep.

[00:49:33] Marie: I suspect you're like you've already been googling which courses...

[00:49:37] Bronwyn: Well, because, yeah, it's something of interest to me, but, like, From what we discussed last time, it is like, I am hearing what you're saying. Like, you don't actually need to go to a full on master's in family therapy. There are some courses like, you know, short PD that you can do to upskill or even if you get a textbook and then you get the regular supervision. Like, you can actually introduce these sort of family therapy concepts and, yeah, like, way of practicing into your practice.

[00:50:04] Marie: Yeah. Absolutely. And starting to think about reflecting on your own stuff as well. So all of that is really useful. You don't feel like, you have to get it perfect to start your first session thinking about the family.

[00:50:19] Bronwyn: Yep. So, Marie, I feel like we're coming towards the end of this episode. Was there anything that we have not addressed that you think would be good for the listeners to hear.

[00:50:31] Marie: I think for me, I would always be thinking about the family and, where possible, drawing even with individual clients, a genogram just to get a bit the lay of the land. And then I also kind of try and kind of figure out who's in their household. So if it's a housemate like, I wanna sort of understand what's happening relationally and and getting a bit of a sense of that. And that can be a really helpful sort of start is to think about what are the the resources for that person? Who are the other people?

[00:51:03] And if they sort of comment on, oh, no, no one talks to dad anymore or there's a you know, you might think, well, a cut off there. I'm just gonna hold that in mind and and starting to sort of map out what might be happening. Because the more I learn about systems and relationships, the more I think some of our responses that we pathologize as a mental illness makes so much sense when we think of someone's experience and what's happened to them.

[00:51:28] And it it it just doesn't feel right for me anymore to think about it exclusively as this is a mental illness. This is the diagnostic criteria that fits neatly into the DSM, and this is the pharmacological therapy. This is the structured treatment, and then you're going to be amazing. I can't... I can't ignore the impact of relationships and family or partner or kids when working with that anymore.

[00:51:52] Bronwyn: And I think that's really wonderful because sometimes we do downplay, and quite often psychology, like we do, we we prioritize the DSM diagnosis over perhaps assessing more thoroughly the relationship. So, yeah, I think that's really important and something for all of us to take away the importance of these dynamics.

[00:52:12] Marie: Or even both because let's say you've got a really clear, I don't know, arachnophobia. Okay. We can diagnose that. We know that maybe EMDR might be really great. But if you're going camping with your family over Christmas, how they respond to your fear of spiders might exacerbate that. Whether you avoid going because you don't know how to say I'm scared of spiders. So there's still a relational component to a very clear diagnosis.

[00:52:43] And so that can be where you help someone set boundaries, expectation, maybe they need to come in and say, I know that you don't think that there's such thing as a fear of spiders. It leaves... it leaves this person feeling like You don't support them. You don't love them and I know as a parent, you don't want that. So sometimes you can you can even just think about how everyone reacts to that because it would be the for a physical health issue.

[00:53:08] Bronwyn: Very important things to consider. Yes. You've given me a lot to think about, and I think a lot for listeners to think about as well. I hope this was a good primer for you listeners, and thank you so much, Marie, for coming on the podcast. It's been such a pleasure to have your expertise and time. Thank you so much. We really appreciate it.

[00:53:23] Marie: No worries. And maybe we have another case. Maybe not so... ChatGPT makes really funny words. It's really...

[00:53:31] Bronwyn: It yeah. It does. Yeah. I just love the like, beneath the facade lies a complex web of issues. That was so funny.

[00:53:39] Marie: Yeah. But if people want some resources, I would encourage them to loop up and I think I mentioned it in the last one. I don't know if it was before... after we recorded it or not. But Diane Gehart, g e h a r t, she's got a book called Mastering Competencies in Family Therapy. She has an online YouTube series. Jenny Brown has some really great resources that the Parent Hope Project and her book, Growing Yourself Up, is also really great. I'll be interviewing her on my podcast actually, this week. So I'm rereading that book and, like, scribbling all highlighted notes and stuff.

[00:54:12] Bronwyn: Wow, that's so cool. And so, Marie, tell us what your podcast name is in case listeners wanna look it up.

[00:54:17] Marie: Yeah. So it's called "This Complex Life", and it's all conversations around mental health, well-being, relationships. Not necessarily targeting therapists. So it's a sort of thing that I hope can be a companion to therapy or each episode on its own can be a stand alone sort of self help food for thought kind of episode. And, uh, for actual people wanting to do training, my website, marievakakis.com, has some current events coming up and some on demand training all around working with young people, with families, um, sort of structuring in the counseling sort of session and a number of things that I'm releasing in 2024.

[00:54:56] Bronwyn: Fantastic. Well, thank you so much again, Marie, for coming on. Um, It's been a real pleasure to have you, and thank you listeners for listening. Have a good one, and catch you next time.